Hello,
What are your opinions on different types of clotting agents.  I know a brand called woundstat was the mil favorite till problems arose.  I have had quick clot on call for the last few years, but its near the end of its shelf life and I will be replacing it in the next few weeks.
Does anyone have opinions or recommendations on any of these products.  Most likely application will be to arteries opened in an automobile accident as I carry this in my vehicle, but I would use it for any emergency major bleeding injury and would favor it over turnicate.

Thanks

I would not worry about the date unless you are a first responder of some sort or other liability issue.  The date is for liability due to possible poor storage issues- worst case product life.  Even field dressings now have an expiration date.  We were given 1950's dated dressings in 1991!  That said I prefer Celox or Quick clot combat sponges.

Quik Clot puts an expiration date on it because the packaging will degrade over time.  If the packaging is no longer air tight the quik clot will start absorbing moisture from the air so when the time comes to use it, it won't work. So as long as the package is still air tight it’s still good to go.  

hemcon is good stuff but it is a small sponge and is not just poured into the wound, it can be cut up to deal with multiple wounds and is fast to work. the video of the pig artery comes to mind.

celox is good from what i hear but i dont know first hand, the idea is its not exothermic like quik clot

the new craze seems to be the quikclot combat gauze, thats what is being issused across the board here in the army. looks like good stuff but i dont know, never been shot!

DO NOT choose these items over a tourniquet, TQ first high on a limb forearm or thigh, and then apply a hemostatic agent. the reason you TQ high is there is only one bone and artery with muscle to worry about, you get down a limb and there are 2 bones with the artery getting smaller and branching off. dont worry about "saving as much of the limb as possible" a TQ has to be left on for a long time, think hours before it gets bad. always carry a TQ, always. good luck. maybe a real medic an help you out more.

We have the Quik-Clot sponges in our IFAKs. I also have some Celox and a Celox-A from home, which I personally believe is better due to the 'no burn' nature of the product.

A tourny can be used in quite a few ways. We were trained to apply the tourniquet just tight enough to slow most of the bleeding, than apply the (whatever hemostatic you use), than apply the bandage, than very slowly untighten the tourny (to avoid 'popping the clot').

All these items have an expiration and if you are an EMT or other licensed healthcare provider you prob. should follow that for liability purposes. However in reality these items will work long after they expire, prob. many years. These items don't suddently vaporize or deactivate on their expiration date. However items that are FDA approved are required to have an expiration date and all this designates is how far past the manufacture date they have tested and proved it's still effective, they had to stop testing somewhere. Hey then you have to go buy more product to replace the expire stuff right!

First thing to mention about bleed control agents. These are not first line bleeding control measures. A tourniquet (TQ) and direct pressure are always your first line items to control bleeding on compressable wounds (arms and legs). A doc that I instruct with were just having this conversation two days ago. Aprox. 90+% of bleeding will stop with this alone and nothing else. If you have the ability to hold pressure on a wound or can apply direct pressure at a pressure point this will work. Pressure dressings and TQ's just allow you to do this and still have your hands free to do things like shoot, call for help on your phone or radio, ect. All any of this does is buy to time to get to definative medical care, same with bleeding control agents.
Hemostatic agents come into play by speeding up the bodies clotting mechanisms. They are not magic wonder drugs, no. Do they help, yes. Do I carry them yes.
The place I feel these items are particularly of use is in partly compressible woulds like groin wounds. Their are really large things in there that bleed a lot and it's difficult to put pressure on them. You can stuff an ACS sponge or two in there or pour it full of celox and pack it full of compressed gauze, wrap the whole pelvis together to put pressure on it and send your patient away on a helo for an evac. to go see a vascular surgeon. The previous options that were available was to try to control the bleeding by other means and it often did not work as desired( think - sceen in Blackhawn Down in casualty collection point where medic tried to clamp artery).

As far as bleed control product selection there are a lot of good choices and none of them suck. All of the commonly available products work and work well. Some are better than other for the circumstances in which you may be using them. i.e. a large quick clot sponge (about the size of a small fist) will not do you a damn bit of good when you can not stuff it into a small 9mm wound (smaller than your little finger). The skin is not bleeding much it's the tissue (blood vessels and arteries) under it is and the bleeding products must contact the area that is actually causing the bleeding to work.

We'll look at the commonly available products:

Hemcon - Very expensive, I didn't like this item until I actually used it the first time. It's actually approved for hospital use and a few ER's and EMS services use it for really bad bleeding. I think it's the shit for facial and neck cuts or wounds where I can see the artery or vessel. The difficulty with Hemcon is you have to get the patch directly over the end of the artery or vessel for it to work optimally. Also once the active surface contacts blood and the chitosan activates it sticks like no bodies business, which includes to your hands or gloves or the floor if your drop it. So it's very technique specific to achieve optimal performance and if you screw up you screw up about $180.00 for a 4X4. There is also the Chitoflex product them make. It's a long strip of the Hemcon bandage and both surfaces are active. It's designed to stuff into wounds but it's even more expensive and difficult to use since your hands/gloves are all bloody and you are trying to stuff this very sticky item into a wound, but if your can do it and do it quick before it sticks to you, it works great.

Celox - This grandular product is made out of the same stuff as the Hemcon Bandage. Like Hemcon it's non thermogenic. I know folks with lots of combat medical experiance (18D and such) that either love or hate this stuff. Ask 5 people and you will get 5 diff. opinions. Since it's grandular you can pour it into small wounds. You do need to get the blood out of the way and get the product gown to the bleeding surface. If you pour it on top of the blood it will sit on top of this and not work well, this is true of all of the products except for the Woundstat that is not longer available. They advertised I would work in the pressence on large pools of blood in the wounds. I never got a chance to use it. Since it's not available we will not go into W.S. Back to Celox - Celox is cheap, realitive speaking. If all I got issued or had available was Celox I would not feel cheated but I don't carry it since I pretty much have unlimited options on what I carry.

Quick Clot ACS -  A quick word on Q.C. if you have the old grandular or the original ACS (advanced clotting sponge) get rid of it, this is the stuff that is very thermogenic and will cook the meat. The ACS + gets warm but not enough to cause thermal injury. Application involved having to get this sponge down to the injury, they do have small 25g sponges (pouches) that will fit in a smaller wound but you still have to have a big enough hole to get it in. So the places where I feel it's best is if you have a large penitrating injury and I need to pack it off, I go to a Q.C sponge or if I need a second line agent b/c the first one failed I may go to Q.C. About the same cost as Celox. Q.C. works not by directly sealing off the vessel but but absorbing all of the liquid out of the blood and basically speeding up the clotting process. You are left with read blood cells and platelets at the point of bleeding. This is an overly simplifed description but a detailed description of how all these work is way too much to type and you can google for this info. All of the current Q.C. products the ACS+ and First Responder are all the same product, just diff. packaging look. Also one off label trick if you have only Q.C. sponge on hand and have a small wound is to cut the packet open and pour the product into the wound, much as you would the Celox or older Q.C. product. It works this way too, very well it apears. The Sponge was developed after some cases of a medivac helo's rotor blast blowing the granular product all over the place and other cases of desert wind blowing product around. I don't know if it ever happended but there was fears of this stuff blowing in peoples eyes, getting hot and causing eye injury and actually creating more casuaties.

Quick Clot Combat Gauze - Looks almost like any other compressed gauze product (Kirlex) that you may stuff into a wound. However it contains a Kaolin product that accelerates the clotting process. It's inexpensive and required no additional training and is non thermogenic. If you know how to properly stuff a wound with Kirlex and hold pressure you already know how to use this product. Does it work better than the QC ACS, I don't think so. I have used them side by side and they both worked almost 100% the same but I can stuff the Combat Gauze into a small wound and ball the unused part on top to use under the pressure dressing to apply even more pressure directly over the wound. You already need to carry compressed gauze in your kit anyway so I can substitute this and it's one item that will serve two purposes. It's more expensive that a $2.00 roll of compressed Kirlex but not any more expensive than a roll of Kirlex + a pack of Q.C. or Celox.

Anyway sorry this is so long. Hope this helps folks a little bit with their agent selection. Sorry there are no hard fast answers peaople just needs to find the best product that fits their circumstances. My standard agents I carry are Combat Gauze and Hemcon on my , in my IFAK with Q.C. ACS as a secondary or rescue agent somewhere close.

Good info.....thanks.

awesome, thank you ray
I think i am going with quick clot combat gauze from your info as that sounds like the most solid all around use and it can replace basic gauze

Brilliant, and tack-worthy

Celox has a "combat gauze" as well.  I even have some for sale in the EE

Some great info here.  I always carry a tourniquet.  I like the SOF model the best and carry one over the CAT but they work great too.  Check out the SOF here:http://www.youtube.com/watch?v=NgGpWWK5bhI

Good information, thanks for the product comparison.

where does a civilian get Q.C. combat gauze or celox?

just use a tampon......





sorry. i don't know why i have to poke that fire every time this subject comes up. it's just funny.

Chinook Medical is a good source

Its cool, I laughed some.  Humor is important in life

Got any to spare?

it's a reference to a thread from about a year ago that hit the archives. it was very entertaining

Sorry folks I have been away from all computers for a few days, this is always a good thing.
You very welcome. I try not to push, in a public forum, any one companies product. Since there are lots of diffrent opinions on these. I can put two very experianced combat medics in a room and both will make 100% valid points for two diff agents and why the other product is not any good. It's based on there own experiance and confidence level. As I said none of them suck, IMHO. I will draw a line on TQ's. There has been some extensive studies on these and there are some not so good TQ's out there. The two that are tried and true are the CAT and the SOF-T, Both are effective. There was a study on TQ's presented at the Special Operations Medical Association Confrence in Dec. 2008. There are some not so effective TQ's on the market. Some of them may stop bleeding at some point but there is a saying "all bleeding eventually stops" Stick with the proven two above.

The biggest message that we try to convey is hemostatic agents are not first line items for controlling bleeding and they are not magic. Their effectiveness is dependent upon proper application under the currect circumstances. The combat gauze is a great option to carry for most people. It is effective and it's knuckle dragger simple to use.

ray9101 gives some really good advice.  Everyone has an opinion, but I would only buy Combat Gauze if I had to buy a hemostatic agent for myself.

Can always try BP Medical Supplies or PMI (Progressive Medical International).

The use of a temporary tourniquet has actually been authorized by National Registry as a BLS technique, drawing mainly from the experience of combat medics in Iraq and Afghanastan.  Tourniquets have been used quite succesfully in just the way this gentleman posited, being on just long enough to slow the bleeding enough to allow placement of a bandage, or even as a first line method to just control the bleeding until the pateint can be gotten to an aid station.

Complete VOKS or individual items

Current evidence is holding that a tourniquet can remain in place up to 2 hours before serious issues with tissue necrosis occurs.  IThat is one time constraint.  I am guessing a second one is still the mind-set that occured mainly with the old, improvised, touniquets; mainly that once you put one on, you can kiss the limb goodbye.  That may even have been true trying to use a bootlace or rolled up cravat as a tourniquet, but modern.professional ones are much better.  I suppose it really depends on your enviroment,  If you have a rig on the way, and can look forward to seeing an ER in an hour or less, I suppose there isn't that much of a need.  If you were hiking the appalacian trail, I may consider removing it (if I had the bleeding under control).  If I feel I may need the tourniquet again (even though they are supposed to be disposable), I may also consider it.

The problem comes from focusing on how we would use it, and not consider the applications other people may need it for.  I have a paramedic partner who refuses to even consider the CAT, and says that an over-inflated BP cuff is all you need.